Abstract
Introduction Chronic periodontitis is a prevalent inflammatory disease that leads to the destruction of tooth-supporting structures. Psychological stress is a potential risk factor for periodontitis, potentially exacerbating inflammation and impairing treatment outcomes. This study aims to explore the correlation between chronic stress and oral inflammatory burden, as measured by the Periodontal Inflamed Surface Area (PISA), in a sample population from Bhopal, India. Methods This randomized clinical study included 1,250 participants, divided into three groups: Group A (control, n=250), Group B (chronic periodontitis, n=500), and Group C (post-treatment chronic periodontitis, n=500). Participants underwent a comprehensive periodontal examination, including the calculation of PISA, and completed the Perceived Stress Scale-10 (PSS-10) to assess stress levels. Statistical analysis included Pearson's correlation to assess the relationship between PSS-10 scores and PISA, with comparisons among groups using analysis of variance or Kruskal-Wallis tests. Results Group B exhibited significantly higher periodontal parameters and PSS-10 scores than Group A and Group C (p<0.001 for all comparisons). Group C showed significant improvements in both periodontal parameters and PSS-10 scores following treatment (p<0.001). A positive correlation was observed between PSS-10 scores and PISA in Group B (r=0.62, p<0.001), indicating that higher perceived stress was associated with increased oral inflammation in untreated chronic periodontitis. This correlation persisted after adjusting for confounders, including age, sex, and socioeconomic status. Conclusions Chronic stress is significantly associated with increased oral inflammatory burden in patients with chronic periodontitis, suggesting that stress may act as an independent risk factor for disease progression. Periodontal therapy reduces oral inflammation and alleviates psychological distress. Integrating stress management into periodontal treatment plans may enhance patient outcomes, highlighting the importance of a holistic approach to periodontal care.